The Pitfalls of a Positive Concept of Health\u27

Objectives: To present and discuss options to both the dichotomous and reductionist biomedical model, and to the difficulties that such alternatives imply for the concept of extended health coverage

Demographics and Outcomes of Pulmonary Hypertension Patients in United States Emergency Departments

Introduction: Pulmonary hypertension (PH) is a common, yet under-diagnosed, contributor to morbidity and mortality. Our objective was to characterize the prevalence of PH among adult patients presenting to United States (US) emergency departments (ED) and to identify demographic patterns and outcomes of PH patients in the ED.Methods: We analyzed the Nationwide Emergency Department Sample (NEDS) database, with a focus on ED patients aged 18 years and older, with any International Classification of Diseases, Clinical Modification (ICD)-9-CM or ICD-10-CM diagnosis code for PH from 2011 to 2015. The primary outcome was inpatient, all-cause mortality. The secondary outcomes were hospital admission rates and hospital length of stay (LOS).Results: From 2011 to 2015, in a sample of 121,503,743 ED visits, representing a weighted estimate of 545,500,486 US ED visits, patients with a diagnosis of PH accounted for 0.78% (95% confidence interval [CI], 0.75- 0.80%) of all US ED visits. Of the PH visits, 86.9% were admitted to the hospital, compared to 16.3% for all other ED visits (P <0.001). Likewise, hospital LOS and hospital-based mortality were higher in the PH group than for other ED patients (e.g., inpatient mortality 4.5% vs 2.6%, P < 0.001) with an adjusted odds ratio (aOR) of 1.34 (95% CI, 1.31–1.37). Age had the strongest association with mortality, with an aOR of 10.6 for PH patients over 80 years (95% CI, 10.06–11.22), compared to a reference of ages 18 to 30 years.Conclusion: In this nationally representative sample, presentations by patients with PH were relatively common, accounting for nearly 0.8% of US ED visits. Patients with PH were significantly more likely to be admitted to the hospital than all other patients, had longer hospital LOS, and increased risk of inpatient mortality

Outpatient regulation system in health management: economic benefits of technological innovations

Purpose – The purpose of this paper is to evaluate the economic benefits of managing an outpatientappointments system with technological innovations.Design/methodology/approach – This study uses a quantitative methodological procedures aiming toevaluate the cost-benefit relation and also the payback of the management and operation of an outpatientappointments system with technological innovations.Findings – This study found a great benefit-cost relation of 30.6 showing the great economic value andsocial impact of managing an outpatient appointments regulation system with technologicalinnovations.Research limitations/implications – This study presents contribution to the literature discussionabout the economic evaluation of the benefits of managing and operating more effective outpatientappointments systems because of important technological innovations.Practical implications – This paper presents and discusses the most important and commonly usedstrategies and technological innovations to deal with and to manage an outpatient appointment regulationsystem aiming to reduce the patient no-show rates.Social implications – The findings of this study show a great benefit-cost relation of about 30.6 which isbeing reverted to the society.Originality/value – There not exist many similar studies in the pertinent literature, mostly with theBrazilian contexts

What is a Freestanding Emergency Department? Definitions Differ Across Major United States Data Sources

Introduction: Despite the growing number of freestanding emergency departments (FSED) in the United States (US), FSED definitions differ across major US data sources of healthcare facilities and use. We compare these sources and propose a universal definition of FSED (and its two major types) to improve communications regarding these facilities and their patients.Methods: We collected definitions of FSEDs from 11 national data sources using their websites, email, and telephone communications. For each source, we asked how they define FSEDs, whether being open 24/7 is a requirement to be called an ED, and whether they maintain a dataset of FSEDs.Results: Definitions varied across the data sources. All sources recognize FSEDs in their definitions, regardless of type; only one (the National Health Intervew Survey) does not differentiate them from other EDs. Five of the 11 sources (45%) omit autonomous FSEDs from their definitions and do not separately identify satellite FSEDs from their affiliated hospitals. One source does separately identify satellite FSEDs from their affiliated hospitals, but also omits autonomous FSEDs. Furthermore, three of the 11 sources (27%) do not require being open 24/7, while all others (73%) employ this criterion. Six of the 11 (55%) maintain datasets of FSEDs using their definition.Conclusion: As FSEDs continue to change the landscape of emergency care, it is important that they also be represented in national ED data sources. The current differences in the definition of an FSED make it difficult to provide accurate and longitudinal analysis for these facilities and patients who receive services at these facilities. We propose a universal definition of FSEDs as described by both the American College of Emergency Physicians and the National Emergency Department Inventory. Implementing a standard definition would facilitate a more accurate representation of FSEDs in national data sources and enhance ongoing efforts to improve the quality of emergency care delivered in FSEDs

Public health and the knowledge industry

El conocimiento desempeña papel importante en el cuidado de la salud. La producción y difusión del conocimiento en salud están actualmente cada vez más bajo control de intereses comerciales privados, caracterizados por conflictos de intereses que resultan en abusos de poder. A pesar de que esfuerzos considerables hayan sido dedicados al estudio del complejo médico-industrial y su papel en la producción de tales desequilibrios de poder y abusos consecuentes, poca atención ha sido dada al papel desempeñado por la industria de publicación, que puede estar sujeta a los mismos problemas. La idea ampliamente difundida de que "cambios importantes y frecuentes" ocurren en la medicina, aunque sin claro apoyo en evidencias, es una herramienta de marketing efectiva de las industrias farmacéutica e de la publicación, que se alimentan de la inseguridad de los médicos. La producción y distribución del conocimiento deberían ser abordadas como un componente estratégico de la salud pública.Knowledge plays an important role in health care. The production and diffusion of health-related knowledge are increasingly under the control of private commercial interests, which are characterized by conflicts of interests that result in abuses of power. Considerable research has been done on the medical-industrial complex and its role in the production of power imbalances and the consequent abuses, but little attention has been dedicated to the role played by the publishing industry, which can be subject to the same problems. The widely diffused idea that "frequent and major changes" occur in medicine, albeit unsupported by clearcut evidence, is an effective marketing tool for both the pharmaceutical and publishing industries, who feed and thrive on physicians' insecurities. The production and distribution of knowledge should be addressed as a strategic component of public health.O conhecimento desempenha papel importante no cuidado em saúde. A produção e difusão do conhecimento em saúde estão atualmente cada vez mais sob controle de interesses comerciais privados, caracterizados por conflitos de interesses que resultam em abusos de poder. Embora esforços consideráveis tenham sido dedicados ao estudo do complexo médico-industrial e seu papel na produção de tais desequilíbrios de poder e abusos conseqüentes, pouca atenção tem sido dada ao papel desempenhado pela indústria de publicação, que pode estar sujeita aos mesmos problemas. A idéia amplamente difundida de que "mudanças importantes e freqüentes" ocorrem na medicina, ainda que sem claro apoio em evidências, é uma ferramenta de marketing efetiva tanto da indústria farmacêutica quanto da de publicação, que alimentam a e se alimentam da insegurança dos médicos. A produção e distribuição do conhecimento deveriam ser abordadas como um componente estratégico da saúde pública

An Evaluation of the Operational Restrictions Imposed to Congonhas Airport by IAC 121-1013

The objective of this study is to propose a review of the operational restrictions imposed on Congonhas airport by IAC 121-1013, seeking a balance between flight safety and operational efficiency. The researchers calculated the landing performance (using specific software), taking into account particular aircraft system failures that increase landing distance. The results indicated that the measures imposed by the IAC have little or no effect on the operational safety increase. Additionally, the restrictions created operational complexity for the airport and reduced its efficiency by impacting airline costs. At the end of the study, the researchers suggest a reissue of the IAC based on the data presented

Treatment of landfill leachate: Removal of ammonia by struvite formation

This paper presents a study of ammoniacal nitrogen removal by chemical precipitation resulting in the formation of ammonium and magnesium phosphat (MgNH4PO4·6H2O), known as struvite, from the leachate in the Delta A landfill, located in the city of Campinas, São Paulo, Brazil. After the addition of a magnesium source (MgCl2·6H2O), and phosphorus  (Na2HPO4·12H2O), ammoniacal nitrogen was precipitated as highly insoluble salt. The removal of ammoniacal nitrogen from the leachate exceeded 85% when the reaction was performed at an initial pH of 10.0. The highest  efficiencies were achieved when the molar ratio between the ions involved in the reaction, i.e., Mg2+:PO43-:NH4+, was 1.2:1.0:1.0, respectively.Keywords: landfill, leachate, ammonia, nitrogen remova

An Evaluation of the Operational Restrictions Imposed to Congonhas Airport by Civil Aviation Instruction121-1013

Due to aircraft accidents, in 2008, operational restrictions were imposed on Congonhas airport by IAC 121-1013. These restrictions sought to create a balance between flight safety and operational efficiency. The purpose of this research was to investigate the results of the operational restrictions. The researchers calculated the landing performance (using specific software), taking into account particular aircraft system failures that increase landing distance. The results indicated that the measures imposed by the IAC have little or no effect on operational safety. Additionally, the restrictions created operational complexity for the airport and reduced its efficiency by impacting airline costs. Finally, the researchers suggested a reissue of the IAC based on the data presented